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Pance Prep Pearls > Neurology > Flashcards

Neurology Flashcards

1
Q

When can an individual resume strenuous activity after a concussion

A

After resolution of symptoms and recovery of memory as well as cognitive functions

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2
Q

Abortive migraine therapy antiemetics and adverse effects of them

A

Metoclopramide, chlorpromazine, prochlorperazine, adverse effects include extrapyramidal symtpoms such as acute dystonic reactions, IV diphenhydramine can be given to prevent these reactions

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3
Q

Acute management of cluster headache (2)

A
  • 100% oxygen

- Antimigraine medications can help during acute attack like sumatriptan

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4
Q

Prophylaxis prevention against migraine headache vs cluster headache

A

Propranalol vs verapamil first line

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5
Q

Idiopathic intracranial hypertension definition

A

Increased CSF pressure with no clear cause evident on neuroimaging, seen most often in obese women of childbearing age, presents with headache that is pulsatile and worse with straining, funduscopic exam reveals papilledema bilaterally and can have visual changes or field loss that can lead to blindness if not treated, diagnosed with a CT prior to LP to rule out intracranial mass, and LP demonstrates increased CSF pressure with otherwise normal CSF, treated first line with acetazolamide and weight loss and sometimes furosemide or steroids as adjunct

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6
Q

CSF findings in MS, guillain barre, bacterial meningitis, viral meningitis

A

MS - high IgG
Guillain barre - high protein with normal WBC/cell count
Bacterial meningitis - high protein with WBC, decreased glucose
Viral meningitis - normal glucose, increased WBC’s particularly lymphocyte predominance

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7
Q

Most common cause of neonatal bacterial meningitis

A

Group B strep

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8
Q

Most common cause of acute bacterial meningitis in adult

A

Strep pneumoniae

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9
Q

Management for bacterial meningitis

A

Antibiotics such as vancomycin + ceftriaxone and dexamethasone, post exposure prophylaxis with cipro to prolonged close contacts

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10
Q

2 most common causes of aseptic (viral) meningitis

A

Coxsackievirus and echovirus

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11
Q

Encephalitis definition

A

Infection of brain parenchyma, most commonly caused by HSV1 and will have meningeal symptoms but also presence of altered mental status and focal neural deficits (hemiparesis, sensory deficits, etc), PCR testing of CSF fluid most accurate to determine herpes encephalitis, treated with IV acyclovir

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12
Q

Treatment option for essential tremor

A

Propranolol

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13
Q

Essential tremor vs parkinson disease

A

Tremor affects head and voice in essential tremor and is also intentional worsened with movement as opposed to a resting tremor characteristic of parkinson’s

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14
Q

Treatment of parkinson disease (3)

A
  • Levodopa carbidopa combo most effective for treatment, can cause dyskinesia and long term use associated with waning effectiveness
  • Dopamine agonists like bromocriptine can be used first line in younger patients <65 to delay use of levodopa
  • Amantadine low potency can help with early symptoms
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15
Q

ALS characteristics presentation

A

Asymmetric limb weakness initially, difficulty chewing, aspiration, mixed upper and lower motor neuron signs, (spasticitiy, hyperreflexia, but also fasciculations, muscle atrophy, weakness), sensation, eye movement, sphincter funciton, and sexual function are spared, usually fatal within 3-5 years due to respiratory failure

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16
Q

Drug given for involuntary movement disorders like managing huntington’s and tourettes

A

Tetrabenazine

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17
Q

Tourette disorder definition

A

Idiopathic movement disorder characterized by vocal and motor tics usually onset in childhood and idiopathic, most often motor tics are first, diagnostic criteria requires onset prior to age 18 and not caused by other substance or medical condition seeing multiple motor and 1 or more vocal tics not required concurrently for >1 year since the first tic, maangement is primarily habit reversal therapy first line and most don’t need medical management but tetrabenazine is an option

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18
Q

Cerebral palsy definition

A

CNS disorder with msulce tone, movement, or postural abnormalities with spasticity being the hallmark

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19
Q

Treatment of choice for restless leg syndrome

A

Dopamine agonists like pramipexole or ropinirole

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20
Q

Work up for restless leg syndrome

A

Iron work up as can be part of underlying causes

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21
Q

Bell palsy clinical manifestation

A

Sudden onset ipsilateral hyperacusis for 24-48 hours followed by unilateral facial weakness or paralysis involving the forehead such as unable to lift affected eyebrow, wrinkel forehad, smile, drooping of corner of mouth, only affects the face

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22
Q

Bell palsy treatment (2)

A
  • No treatment other than supportive

- Prednisone possibly

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23
Q

Guillain barre syndrome presentation

A

Symmetric ascending weakness and sensory changes, if severe could cause respiratory failure but most recover within a year without permanent disability

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24
Q

Management of guillain barre

A

Plasmapheresis or IVIG first line

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25
Q

Clinical presentations of myasthenia gravis

A

Generalized muscle weakness and ocular weakness (diplopia and ptosis usually first presenting symptom) that is worsened with repeated muscle use and at the end of the day

26
Q

Myasthenia gravis diagnosis

A
  • Acetycholine receptor antibodies initial test of choice

- In inpatient emergent setting tensilon (edrophonium) test (brief improvement after administration) or icepack test

27
Q

Management of severe myasthenia gravis vs long term medical management

A

Plasmapheresis or IVIG, long term acetylcholinesterase inhibitors like pyridostigmine or neostigmine first line

28
Q

Lambert Eaton syndrome definition

A

Proximal muscle weakness that improves with repeated muscle use (may see difficulty arising from chair), tested with antibody assay, associated with small cell lung cancer and other malignancies so goal is to treat underlying malignancy but can also use pyridostigmine

29
Q

Most common type of MS

A

Relapsing remitting

30
Q

Physical exam findings in MS

A
  • Upper motor neuron signs like spasticity, babinksi, hyperreflexia, muscle rigiidty
  • Positive lhermitte’s sign
  • Spinal cord symptoms like bladder, bowel, or sexual dysfunction
31
Q

Best initial and most accurate test for MS, what is one other one if this test is negative?

A

MRI with gadolinium demonstrating hyperintense white matter plaques

LP if negative MRI dmeonstrating increased IgG and oligoclonal bands

32
Q

Management of acute exacerbation of MS and prevention of relapse or progression

A

IV high dose glucocorticoids first line

Beta interferon

33
Q

Most common and aggresive primary malignant CNS tumor in adults

A

Glioblastoma

34
Q

Alzheimer dementia pathophysiology hypotheses

A

Amyloid extra cellular protein deposition senile plaques, tau neurofibrillary tangles,

35
Q

Clinical manifestation of alzheimer dementia

A

Short term memory loss often first symptom, progresses to long term memory loss and cognitive deficits, disorientation, behavioral changes, gradual by nature

36
Q

Preferred neuroimaging test for alzheimer dementia (even though it is a clinical diagnosis)

A

MRI

37
Q

Medical management for alzheimer dementia (2)

A

-Acetycholinesterase inhibitors like donepezil or rivastigmine and NDMA antagonist like memantine as adjunct or monotherapy in moderate to severe disease

38
Q

Vascular dementia definition

A

Brain disease due to chronic ischemia and multiple infarcts (lacunar infarcts), hypertension most important risk factor, sees sudden decline of function in a stepwise progression of symptoms, clinical diagnosis but work up is similar to alzheimer disease and often an MRI is done

39
Q

Frontotemporal dementia (Pick’s disease) definition

A

Localized brain degeneration of frontotemporal lobes, sees marked changes in social behavior, personality, and language, often onset is earlier than alzheimer’s, disinhibition or socially inappropriate behaviors

40
Q

Diffuse lewy body disease definition

A

Dementia characterized by diffuse presentation of lewy bodies everywhere in comparison to parkinson disease where they are localized, core features occur early like visual hallucinations, episodic delirium, parkinsonism, dementia is a late finding, management is difficult

41
Q

Todd’s paralysis definition

A

Neurologic deficit after a seizure that mya last for up to 24 hours, can be mistaken for a stroke as it might just affect one arm

42
Q

What 2 antiepileptic medications are safest in pregnancy

A

Lamotrigine and levetiracetam

43
Q

Status epilepticus definition

A

Single continuous seizure lasting 5 min or greater or more than 1 seizure within a 5 min period without recovery between episodes, considered an emergency

44
Q

Status epilepticus management (2)

A

Benzos like lorazepam preferred, phenytoin if no response or loading to prevent recurrence

45
Q

1 risk factor for lacunar infarct and ischemic stroke

A

Hypertension

46
Q

TIA management in non cardiogenic causes

A

Antiplatelet therapy, aspirin, clopidogrel

47
Q

Management of ischemic stroke acutely and outpatient

A

Within 3 hours of symptom onset, alteplase if no contraindications (BP 185/110 or greater, recent bleeding, bleeding disorder, recent trauma), possible mechanical thrombectomy

Outpatient aspirin therapy should not be started until 24 hours after time of thrombolytic therapy but then begin aspirin and clopidogrel as well as a statin regarldess of LDL level

48
Q

Most common artery affected in ischemic stroke

A

Middle cerebral artery

49
Q

MCA ischemic stroke manifesetations

A

Arm deficits greater than leg, facial involvment of lower half of face only (still can raise forehead!!!), aphasia

50
Q

ACA ischemic stroke manifestations

A

Leg deficits gerater than arm

51
Q

PCA ischemic stroke manifestations

A

Vertigo, vomiting, visual changes such as diplopia

52
Q

Epidural hematoma definition

A

Rupture most often of middle meningeal artery, 3 phases, loss of consciousness followed by lucid interval follwoed by neurologic deterioration (talk and die syndrome), biconvex lens shaped hyperdenisty seen in temporal area, managed with hematoma evacuation to prevent death

53
Q

Subdural hematoma definition

A

Rupture of cortical bridging vein after blunt trauma, usually presents with gradual increase in generalized neurologic symptoms, CT dmeonstrates concave crescent shaped banana shaped bleed with possible midline shift, managed either clinically if small or surgical if large midline shift or severe

54
Q

Subarachnoid hemorrhage finding on LP

A

Xanthochromia (yellow or pink color to CSF due to breakdown of RBcs

55
Q

Management of subarachnoid hemorrhage

A

supportive, nimodipine reduces cerebral vasospasms which improves outcomes neurologically, prevention of rebleeding is done with endovascular surgical clipping

56
Q

Compressive axial load on back of head fracture and how is it managed?

A

Jefferson (burst fracture of c1) such as jumping into pool, managed with external immobilization for 6-12 weeks

57
Q

Odontoid process of axis (C2) is at great risk of…

A

….malunion and is an unstable fracture, increases odds of needing surgical repair

58
Q

Extreme hyperextension injury of the skull, atlas, and axis

A

Hangman C2 fracture, unstable

59
Q

Anterior cord syndrome mechanism, deficits

A

Burst fracture or flexion injury, sees worsened lower extremity motor deficits than upper, worst outcome

60
Q

Central cord syndrome mechanism, deficits

A

Hyperextension injuries, upper extremity affected worse than lower in a cape distribution, good recovery

61
Q

Brown sequard syndrome mechanism, deficits

A

Unilateral hemidisection after penetrating trauma most often, ipsalateral motor and vibration/proprioception, contralateral pain and temp deficits, great prognosis

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